| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2030 |
Assist living waiver/month |
4,260 |
3,892 |
$4.08M |
| T2031 |
Assist living waiver/diem |
1,148 |
930 |
$1.54M |
| A9999 |
Dme supply or accessory, nos |
4,006 |
3,078 |
$334K |
| E1392 |
Portable oxygen concentrator |
2,056 |
1,589 |
$168K |
| E1390 |
Oxygen concentrator |
1,410 |
1,292 |
$99K |
| S5161 |
Emer rspns sys serv permonth |
6,989 |
5,454 |
$85K |
| E0601 |
Cont airway pressure device |
1,583 |
1,302 |
$84K |
| 11719 |
|
2,809 |
1,313 |
$67K |
| G0299 |
Hhs/hospice of rn ea 15 min |
368 |
76 |
$50K |
| A0429 |
Bls-emergency |
250 |
170 |
$31K |
| A0428 |
Bls |
304 |
236 |
$27K |
| G0156 |
Hhcp-svs of aide,ea 15 min |
446 |
57 |
$27K |
| A0425 |
Ground mileage |
1,355 |
1,037 |
$27K |
| A0427 |
Als1-emergency |
142 |
108 |
$23K |
| E0265 |
Hosp bed total electr w/ mat |
550 |
432 |
$16K |
| T2033 |
Res, nos waiver per diem |
13 |
13 |
$15K |
| 84443 |
|
836 |
829 |
$11K |
| 82306 |
|
445 |
442 |
$9K |
| A0433 |
Als 2 |
13 |
12 |
$9K |
| 98941 |
|
328 |
186 |
$9K |
| 80053 |
|
1,039 |
1,001 |
$8K |
| G0155 |
Hhcp-svs of csw,ea 15 min |
73 |
41 |
$8K |
| 83036 |
|
901 |
896 |
$6K |
| E0431 |
Portable gaseous 02 |
445 |
392 |
$6K |
| 85025 |
|
775 |
744 |
$5K |
| 80061 |
|
448 |
444 |
$5K |
| 99215 |
Prolong outpt/office vis |
28 |
13 |
$4K |
| 99306 |
Prolong nursin fac eval 15m |
17 |
17 |
$3K |
| K0001 |
Standard wheelchair |
824 |
621 |
$3K |
| 82607 |
|
399 |
396 |
$3K |
| E0562 |
Humidifier heated used w pap |
167 |
166 |
$2K |
| 17250 |
|
30 |
12 |
$2K |
| 80048 |
|
345 |
329 |
$2K |
| U0003 |
Cov-19 amp prb hgh thruput |
31 |
12 |
$2K |
| 84439 |
|
195 |
193 |
$2K |
| E0570 |
Nebulizer with compression |
147 |
141 |
$2K |
| V5299 |
Hearing service |
54 |
53 |
$2K |
| 11720 |
|
34 |
30 |
$1K |
| E1353 |
Oxygen supplies regulator |
268 |
163 |
$1K |
| 82746 |
|
238 |
236 |
$1K |
| 85027 |
|
398 |
390 |
$555.10 |
| K0045 |
Ftrst compl assembly repl ea |
486 |
292 |
$450.00 |
| A7038 |
Pos airway pressure filter |
84 |
81 |
$383.04 |
| 87086 |
|
62 |
61 |
$365.93 |
| P9603 |
One-way allow prorated miles |
19 |
15 |
$256.97 |
| 82570 |
|
52 |
50 |
$209.22 |
| 83735 |
|
185 |
183 |
$205.00 |
| 81001 |
|
62 |
62 |
$190.12 |
| 82043 |
|
25 |
25 |
$177.00 |
| 92015 |
|
15 |
15 |
$150.00 |
| A4615 |
Cannula nasal |
15 |
12 |
$120.00 |
| G0471 |
Ven blood coll snf/hha |
17 |
14 |
$85.00 |
| 86480 |
|
13 |
13 |
$0.00 |
| 98960 |
|
28 |
12 |
$0.00 |
| 83970 |
|
12 |
12 |
$0.00 |
| 97163 |
|
48 |
16 |
$0.00 |
| A7031 |
Replacement facemask interfa |
17 |
14 |
$0.00 |
| A7035 |
Pos airway press headgear |
21 |
19 |
$0.00 |
| 97167 |
|
59 |
16 |
$0.00 |
| E0184 |
Dry pressure mattress |
39 |
25 |
$0.00 |
| 77080 |
|
15 |
12 |
$0.00 |
| A4604 |
Tubing with heating element |
21 |
20 |
$0.00 |
| 82652 |
|
31 |
31 |
$0.00 |
| 83540 |
|
14 |
14 |
$0.00 |
| A7030 |
Cpap full face mask |
14 |
13 |
$0.00 |
| S5102 |
Adult day care per diem |
114 |
24 |
$0.00 |
| E1038 |
Transport chair pt wt<=300lb |
190 |
90 |
$0.00 |
| E0277 |
Powered pres-redu air mattrs |
28 |
24 |
$0.00 |
| 83550 |
|
14 |
14 |
$0.00 |
| 82728 |
|
14 |
14 |
$0.00 |